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REGIONAL ANESTHESIA

Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block

D. Macalou, MD^*, S. Trueck, MD^*, P. Meuret, MD^*, M. Heck, MD^*, F. Vial, MD^*, S. Ouologuem, MD^*, X. Capdevila, MD PhD, J. -M. Virion, and H. Bouaziz, MD PhD^*

*Department of Anesthesiology and Intensive Care, Central University Hospital, Nancy, France, the Department of Anesthesiology and Intensive Care, Lapeyronie University Hospital, Montpellier, France, and the Department of Epidemiology & Clinical Evaluation and Centre of Clinical Investigation, University Hospital, Nancy, France

Address correspondence and reprint requests to Hervé Bouaziz, MD, PhD, Hôpital Central, 54035 Nancy, Cedex, France. Address e-mail to h.bouaziz{at}chu-nancy.fr

Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.

IMPLICATIONS: Femoral 3-in-1 nerve block alone is frequently used for pain control after total knee replacement but does not provide complete postoperative analgesia. This study showed that the addition of an obturator nerve block to femoral 3-in-1 nerve block improves the quality of postoperative analgesia after total knee replacement.

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